DRUGS USED FOR TREATMENT PARKINSON DISEASE

MEDICAL FACULTYUNIVERSITY OF LAMPUNG

ISWANDI DARWIS, MD

PARKINSON DISEASE

TRAP

REMOR

IGIDITY

KINESIA

OSTURALINSTABILITY

Groups ExampleDopamine AgonistLevodopa (L-dopa)CarbidopaBromoriptine

Levodopa, Benserazide (Madopar)

Bromocriptine mesylate (Parlodel)

Indirect Dopamine Agonist (Dopamino-antikolinergik)DeprenylAmantadine

Selegilline (Jumex)

Antimuscarinic AgentBenztropineBiperideneOrphenadrineTrihexyphenidyl

Benzhexol HCl (Artane)

Trihexyphenidyl, Neostigmine metylsulfate, Prostigmine

Inhibitor MAO-BCNS Stimulant (Amphetamine)Tricyclic antidepressants(Amitryptiline)

Levodopa Karbidopa

•Intermediate compounds of cathecolamine synthesis•Trough Blood Brain Barrier and changed by L- decarboxylate aromatic amino acid (dopa-decarboxylate) into dopamin•T ½ 1-3 hour•> 90% metabolized by peripherydepo decarboxylate (CNS outside) into dopamine•The levels to the brain <2%•More effective to reduce rigidity and bradichynesia than reduce tremors

•CNS : Dyskinesia, behavioral changes•GIT : Nausea dan Vomitus•Liver Function Test : slightly increased•Cardiovascular : arythmia, postural hypotensi, hypertensi (high dose)

Advers Effect

•Pyridoxin increase metabolism levodopa•Reserfin (decrease dopamine depo) and neuroleptic (blocking dopamine reseptor) exacerbate parkinsonism•Anticholinergic, tryciclic antidepresan, phenytoin and benzodyazepin decrease effect of levodopa

Drugs Interact

ion

Bromocriptine

•Ergote alkaloids derivate•Agonist of dopamine reseptor•T ½ 8-12 hour•Treatment effect prolonged for several month•Indication : Parkinsonism & Hyperprolactinemia

Toxicity•Involuntary movement, behavioral changes•Nausea and vomite•Arytmia and postural hypotensi•Livedo retikularis

Contraindication

•Myocardium infarction•Mental disorders

•Work by releasing dopamine from presinaptic vesicle•Urine excretion with intact form warning for patient with renal failure•Indication : Parkinson disease, type A influenza infection•Advers effect / toxicity•Behavioral changes•Livedo retikularis•Congestive hearth failure

Amantadine

• Deprenile• Mono Amin Oxidase Inhibitor (MAOI)

• Amantadine• Antiviral drugs• Work by releasing cathecolamine from place of

storage

Indirect dopamin

ergic agent

•Inhibiting competitively muscarinic reseptor in the brain•Effective for reducing tremor but less effective for bradikinesia•Indication•Mild Parkinsonism single dose•Parkinsonism severe relatively combination with dopaminergic agent•Most effective for tremor•Adverse effect same with atropine : confusion, hallucinations, dry mouth, constipation, urine retention

Benztropine and

trihexilphenidin

e

QUESTIONS ?